Assignment task:
A 31-year-old woman complains of tingling and numbness in her lower limbs that started 3 months ago and is progressively worsening. She also complains of fatigue and irregular menses. Her last menstrual period was 2 months ago. She denies weight loss, visual changes, headaches, or constipation. Her past medical history is significant for Hashimoto thyroiditis since she was 21 years old, for which she is taking levothyroxine. Her mother also has hypothyroidism. Blood pressure is 110/81 mm Hg, and heart rate is 70 bpm. On examination, her thyroid is nonpalpable. She has no scleral icterus, and her mucous membranes are moist. There is decreased vibration and proprioception in both of her lower limbs. Her ankle jerk reflexes are absent, and other reflexes are brisk. There are positive Babinski and Romberg signs. Laboratory tests show hemoglobin of 8 g/dL, hematocrit of 22%, white blood cell count of 3,200 cells/mm3, platelet count of 300,000 cells/mm3, total T4 8.2 mcg/dL, and thyroid-stimulating hormone of 2.4 micro UI/mL. What is the next best step in the management of this patient? Need Assignment Help?A. Measure serum vitamin B12 levels B. Measure serum folate levels C. Increase her levothyroxine dose D. Measure serum T3 levels